One in 10 young people in the United States will struggle with mental health issues before age 10, regardless of race or income, and at least half of them will never receive help. These issues can disrupt children’s path to a prosperous life; they often lead to lower school attendance and fewer learning opportunities, and can manifest in physical ailments. Growing awareness of this link between physical and mental health, even at very early ages, has led health care professionals and others working on social change to more deeply examine how global health care systems can treat the whole person for better overall well-being. One emerging model, known as integrated primary care, addresses this intersection by combining behavioral health with primary health care services. We believe this model offers important economic and personal benefits for children and adults alike, as it can make overall care more efficient and effective.
The positive impact of integrated primary care is significant: According to a recent report from the American Psychiatric Association, successful integrated care models have the potential to save the US national health care system $26 to $48 billion annually. And importantly, incorporating mental health into basic primary care enhances treatment for people with multiple health needs while destigmatizing this common, yet often misunderstood, aspect of health.
This is apparent in the case of 9-year-old Michael. Michael had been complaining of severe stomach pain, light-headedness, and unexplained feelings of anger. His mother took him to a primary care physician who works in an integrated care setting with the assistance of a post-doctoral psychologist. Together, they determined that Michael’s symptoms were indicative of a mental health condition called oppositional defiance disorder that was manifesting itself physically. This disorder was also causing him to lose focus on classwork and self-isolate in social settings. Michael began to feel distraught and withdrawn, which led to his physical ailments. After his diagnosis, the physician developed a comprehensive treatment plan, and Michael now thrives in social activities, has improved his grades, and can make it through an entire day of school without any pain or discomfort. Thanks to this integrated care model, Michael and his mother also avoided common pitfalls of undiagnosed disorders in children: trips to several specialists without receiving an accurate diagnosis, prescriptions for unnecessary medications, continued poor school performance, and greater social alienation from peers and family.
However, successful integrated primary care models are often difficult to sustain, for a few reasons. They are expensive to implement and require greater resources to continue delivering services. As health care costs increase overall—not to mention the cost of treating patients with multiple health issues—integrated care initiatives need funding strategies that make them viable for the long term.
Moreover, patient demographics vary widely across the United States, and different populations require different approaches to integrated care. Patients in rural areas, for example, tend to have lower levels of education and higher rates of poor health than their urban counterparts. This places greater stress on rural care models, making it more difficult for them to keep up operations over time.
Of course, these challenges are not insurmountable. Our work at the Naples Children & Education Foundation (NCEF) shows how it is possible to overcome them and establish an integrated care model with long-term success. In 2007, we created the Children’s Mental Health Initiative to further our mission to support programs in Southwest Florida that improve the physical, emotional, and educational lives of underprivileged and at-risk children. Since then, the program has funded and developed a collaborative, preventative model that connects mental and primary health care providers to treat children’s comprehensive health needs in a way adapted to the challenges inherent in serving a rural, low-income population.
Our model prioritizes early detection and prevention, focusing on screening and treating children when the first signs of mental or physical ailments appear; this helps alleviate ongoing problems and reduce the chances that these low-income patients will need costly mental health care later in life. We’ve strengthened this model by facilitating collaboration among partnering organizations and by reaching kids where they are—whether in medical centers, their homes, or at school. Our partnering organizations include local mental and physical health care providers David Lawrence Center and Healthcare Network of Southwest Florida, as well as Florida State University College of Medicine and the National Alliance on Mental Illness.
The collaboration among these varied organizations, which all offer different yet compatible services, occurs in several ways. For example, FSU requires that all psychologists in its program are fluent in at least one of the most common local languages (Spanish or Haitian Creole), and the university connects interpreters with psychologists-in-training, allowing them to become comfortable communicating with our many local patients who do not speak English. We also fund professionals who visit schools and patients’ homes, including a school liaison who serves as a bridge between Collier County schools and the doctors, as well as a community clinician and case manager who can provide in-home or in-school services. These services are especially important for migrant, working-class families with minimal time and resources to visit the doctor. With such a well-established system of targeted services, the initiative satisfies the outsized need of its rural, low-income population.
In addition to collaborating and customizing our work to suit the needs of the people we serve, the Children’s Mental Health Initiative combats rising health care costs that pose a challenge to its sustainability by combining monetary and operational support. For example, as a condition for receiving grants from NCEF, participating organizations must come together for regular meetings to ensure that the program’s collective goals and strategies are aligned, enabling them to maximize efficiency and eliminate redundancies among different partners’ services. This emphasis on teamwork enables the group to determine collectively where the need is and how to staff for that need. Working together, they determine how to fill the new positions in a way that would make them eligible for reimbursement by a third-party managed care program. That, in turn, reduces their reliance on NCEF funding. When the partners do not have sufficient funds for these necessary positions, NCEF commits to funding them for one to two years, giving the provider time to adjust to the managed care system of reimbursement. This is just one example of how our model is making major steps toward financial sustainability.
Ultimately, we have found that we can create integrated care models sustainably and run them effectively if they are diligent about addressing their community’s unique needs, and are constructed on a strong foundation that prioritizes self-reliance and teamwork. This model ensures that effective care can be sustained even when in high demand, and that patients get the best care for their distinct needs. Although integrated care models will face difficulties along the way, community-focused, creative steps like these can help integrated and effective mental and physical health care move from an ideal to a lasting reality.